T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Challenging Diagnosis

Epstein-Barr virus (EBV) is a double-stranded virus that shows tropism for B-cell lymphocytes. EBV-infected patients usually present with tonsillitis/pharyngitis, cervical lymphadenopathy and fever, but an atypical presentation can mimic lymphoproliferative disease. We present the case of a 77-year-old woman with asthenia, fever, oral ulcers and peripheral lymphadenopathy. After extensive evaluation, including anatomopathological and immunocytochemical examination of excisional lymph node biopsy samples, it was still not clear whether the patient had EBV infection or diffuse large B-cell lymphoma. In this case report, the authors describe how it can be difficult to differentiate between two different, although related, entities, making diagnosis of lymphoma highly challenging. LEARNING POINTS: Lymph node biopsy findings may result in lymphoma being misdiagnosed as acute Epstein-Barr virus infection. Immunophenotypic analysis can occasionally be insufficient to establish the clonal nature of the disease. Timely diagnosis of lymphoma is necessary so that immunochemotherapy can be initiated and clinical improvement achieved.